妊娠期高血压孕妇血清铅水平对早产及小于胎龄儿发生的影响

刘佳伟

【摘要】 目的：探究妊娠期高血壓孕妇血清铅水平对早产及小于胎龄儿（SGA）发生的影响。方法：于2017年1月-2020年1月招募2 128例妊娠高血压孕妇为研究对象，对入组孕妇的血清铅含量进行测定，按照其血清铅水平将其分为低血清铅水平组（L-Pb组，n=877）、中血清铅水平组（M-Pb组，n=762）和高血清铅水平组（H-Pb组，n=489），比较不同组别孕妇和新生儿的特征、早产以及SGA发生情况，探究孕妇血清铅水平与早产、SGA风险之间的关系。结果：H-Pb组新生儿的出生体重明显低于L-Pb组与M-Pb组（P<0.05）;三组新生儿的出生身长、头围、胸围比较，差异均无统计学意义（P>0.05）。三组早产和SGA发生率比较，差异均有统计学意义（P<0.05）;且三组中期早产发生率比较，差异有统计学意义（P<0.05）。三组不同性别婴儿SGA发生率比较，差异均有统计学意义（P<0.05）。结论：孕妇暴露于高血清铅水平下会更易出现中期早产和SGA，妊娠期高血压孕妇应着重注意做好防护。

【关键词】 妊娠期高血压 血清铅水平 早产 小于胎龄儿

Effect of Serum Lead Level on Preterm Birth and Small for Gestational Age in Pregnant Women with Gestational Hypertension/LIU Jiawei. //Medical Innovation of China， 2021， 18（14）： -158

[Abstract] Objective： To investigate the influence of serum lead level on the occurrence of premature birth and small for gestational age （SGA） in pregnant women with hypertension during pregnancy. Method： From January 2017 to January 2020， 2 128 pregnant women with high blood pressure were recruited as the study object， the serum lead content of the pregnant women were determined. According to the serum lead level， they were divided into low serum lead level group （L-Pb group， n=877）， middle serum lead level group （M-Pb group， n=762） and high serum lead level group （H-Pb group， n=489）. The characteristics， premature birth and SGA incidence of different groups of pregnant women and newborns were compared， and the relationship between serum lead level and risk of premature delivery and SGA was studied. Result： The birth weight of neonates in H-Pb group was significantly lower than that in L-PB group and M-Pb group （P<0.05）. There were no significant differences in birth body length， head circumference and chest circumference among the three groups （P>0.05）. Comparison of the incidence of premature birth and SGA among the three groups， the differences were statistically significant （P<0.05）. Comparison of the incidence of mid-term premature birth among the three groups， the difference was statistically significant （P<0.05）. Comparison of the incidence of SGA in three groups of infants of different genders， the differences were statistically significant （P<0.05）. Conclusion： Pregnant women exposed to high serum lead levels are more likely to have mid-term preterm labor and SGA. Pregnant women with hypertension during pregnancy should pay more attention to protection.

[Key words] Gestational hypertension Serum lead level Preterm delivery Small for gestational age

First-authors address： Jiamusi Maternal and Child Health Care Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.14.037

铅是一种金属化学元素，是原子量最大的非放射性元素，由于铅具有可塑性好、熔点低、耐蚀性高等特点，因而常被加工为板材和管材，被广泛应用于化工、放射性防护等工业部门中[1]。近些年随着铅在生活中应用率的升高，居民暴露于铅中的风险也明显升高，有调查显示高水平的铅会导致个体骨骼疾病、肾功能障碍、神经发育毒性和造血异常，还有证据表明儿童由于手-口行为较多，对铅的易感性较强，加之儿童血脑屏障和肠黏膜屏障发育尚不成熟，因而儿童成为铅常见的受害者[2]。孕妇以及胎儿对于低水平的铅暴露较为敏感，有学者的调研指出血铅对于妊娠有巨大危害，铅会在怀孕或哺乳期母体的骨骼中释放入血，进而通过胎盘屏障传递给胎儿，因而母体血铅水平的升高会直接影响胎儿的生长发育，导致小于胎龄儿或早产等不良妊娠结局的出现[3]。……